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Chest Infections |

Pelvic and Peritoneal Tuberculosis: A Deceptive Diagnosis FREE TO VIEW

Steven Kim, MD; Igor Eyzner, MD; Alfred Lardizabal, MD; Amee Patrawalla, MD
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University Hospital, Newark, NJ


Chest. 2015;148(4_MeetingAbstracts):85A. doi:10.1378/chest.2278018
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Abstract

SESSION TITLE: Chest Infections Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Mycobacterium tuberculosis (MTB) presents most commonly in the lungs. However, MTB can involve other organs and produce a wide variety of clinical findings. Here, we present three cases of intra-abdominal MTB.

CASE PRESENTATION: An 83 year-old Peruvian woman with rheumatoid arthritis on infliximab presented with lower abdominal pain. CT-Abdomen/Pelvis showed moderate ascites and omental caking. CA-125 was 367. Transbronchial biopsy for diffuse pulmonary opacities grew MTB and biopsy of omental caking revealed non-necrotizing granulomas. A 39 year-old Peruvian woman presented with new-onset amenorrhea. Transvaginal ultrasound showed complex ovarian lesions and CA-125 was 213. Laparoscopy showed uniform miliary nodules diffusely covering all peritoneal surfaces. Biopsy of the nodules showed necrotizing granulomas and MTB was isolated in pleural fluid. A 51 year-old Bolivian woman with history of necrotizing granulomatous interstitial nephritis presented with abdominal pain. CT-Abdomen revealed a 4.7cm heterogenous mass and retroperitoneal lymphadenopathy. VATS lung biopsy for a right lung mass revealed granulomatous pneumonitis with focal necrosis that grew MTB.

DISCUSSION: Pelvic and peritoneal TB are increasingly rare presentations of TB in developed nations. Pelvic TB is most commonly diagnosed in women of childbearing age from endemic countries who have never been pregnant and present with menstrual abnormalities. Peritoneal TB most commonly occurs via hematogenous spread from the lungs, but may also spread from the gastrointestinal or genitourinary tracts. Clinical manifestations are nonspecific and most commonly include ascites, abdominal pain, and fever. Patients may have elevated CA-125 levels, commonly misleading the physician towards malignancy. HRCT may show peritoneal thickening, lymphadenopathy, omental caking, and ascites. Definitive diagnosis is obtained by isolation of MTB by culture or molecular methods. Laparoscopy and peritoneal biopsy may reveal caseating granulomas. Treatment is commonly empiric as diagnosis can be challenging.

CONCLUSIONS: These forms of extra-pulmonary TB have an insidious onset and subtle clinical manifestations that can be deceiving. Diagnosis can only be determined if suspected. It is important that clinicians be familiar with the potential presentations, diagnostic evaluation, and treatment of extra-pulmonary TB.

Reference #1: Kosseifi S, et al. Peritoneal Tuberculosis: Modern Peril for an Ancient Disease. Southern Medical Journal Jan 2009; 102;1:57-59.

DISCLOSURE: The following authors have nothing to disclose: Steven Kim, Igor Eyzner, Alfred Lardizabal, Amee Patrawalla

No Product/Research Disclosure Information


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